The Challenges of the Health Care Providers in Refugee Settings: A Systematic Review

Abstract

Background:All over the world, migration is affecting millions of people who either choose or are forced to leave their countries of origin. Health is considered to be one of the important aspects of migration that is highly influenced by the circumstances created by mobility within or across countries. In the context of forced migration, it is well-established that refugees are susceptible to various diseases and other health conditions which might occur or deteriorate based on the health systems and health care provision in receiving countries. There is a considerable amount of research on the challenges encountered by refugees in receiving countries, in terms of health care systems and services. However, there seems to be little focus on the health care providers’ perspectives of the challenges in health care provision in refugee settings. This review aims to explore some of the articles discussing the challenging issues surrounding refugee health from a provider’s perspective.Methods:A systematic review was conducted through five main online databases: Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA); Science Direct (Elsevier; Amsterdam, Netherlands); Scopus (Elsevier; Amsterdam, Netherlands); Sage (Sage Publications; Thousand Oaks, California USA); and Google Scholar (Google Inc.; Mountain View, California USA), including only the articles published in English. In addition, grey literature resources available online were used.Results:Forty-eight articles were included in this review, mainly based on the amount of emphasis they placed on providers’ viewpoints in refugee health settings. Most of the articles were retrieved based on their availability in the databases which Hacettepe University (Ankara, Turkey) is subscribed to. Almost all of the articles mentioned the challenges caused by linguistic and cultural barriers, and some focused on providers’ limited knowledge and skills, as well as inefficient health care systems. There was little emphasis on ethical discussions, and the physical and emotional impact of caring for refugees on health care professionals. In the few articles discussing ethical and personal dimensions, issues concerning stress, burnout, and safety risks were found to be the recurring themes.Conclusions:Evidence gathered suggests that the challenges faced by health care providers involve a variety of factors that are specific to health care settings involving refugees, such as linguistic and cultural barriers, and a lack of proper support and training. It seems that the challenges that health care providers face in refugee settings could be further investigated both from professional and personal aspects for a better understanding of refugee health care.Kavukcu N, Altıntaş KH. The challenges of the health care providers in refugee settings: a systematic review. Prehosp Disaster Med. 2019;34(2):188–196

Research ethics and refugee health: a review of reported considerations and applications in published refugee health literature, 2015-2018

“…Early community and stakeholder engagement is critical during the pre-investigation phase. Such engagement can help to bridge cultural differences and establish trust within the community, as well as provide an outlet for the community to voice their concerns and thoughts [9,38]. For instance, this engagement can take the form of a formal community needs assessment or informal community-wide meetings to identify the type(s) of services needed or the benefits and risks of a specific Table 5 List of some potential best practices 1 to consider when conducting health-related investigation within refugee populations 2…”

“…Feedback from the community through key informant interviews or focus groups can also shape investigation protocols and procedures to add cultural competence. For example, the content and format of consent can meet participants' information needs, or location of interviews can show respect for the community [9]. Transparency during this phase can address concerns regarding the impact on the community and answer questions for those unfamiliar with the investigational process [6].…”

“…As in the pre-investigation phase, cultural practices should be considered when choosing methods for ensuring privacy and confidentiality [38]. If focus groups are considered necessary for sensitive investigations, optimal standards could include separating the groups by gender, age, religion, or other factors, if deemed appropriate [9,13,38,39].…”

“…Some refugees are subject to continued oppression, restrictions on their liberty of movement, and gross power imbalances within refugee camps [6]. Additionally, low literacy (including health literacy) levels in some refugees can result in communication barriers and low understanding or misinterpretation of the investigation process [6,9].…”

Prevalence of Non-Communicable Diseases and Associated Medication Use Among Syrian Refugees in Lebanon: An Analysis of Country-Wide Data from the Sijilli Electronic Health Records Database

“…Refugees are at an increased risk of health problems due to the traumatic and stressful events they are exposed to pre-, during-and post-the migration journey, coupled with the compromised access to healthcare in host countries (24). Evidence suggests that communicable diseases, NCDs (25,26), mental health disorders mainly depression and post-traumatic stress disorder (PTSD) (27), obstetrics and gynecologic (OBGYN) conditions, accidental injuries, malnutrition and anemia (28) emerge as the top prevalent health conditions among refugees.…”